Castor single-branch stent in treating Stanford type B aortic dissection with insufficient anchorage zone / 中华普通外科杂志

Objective:To evaluate Castor single-branch covered-stent in the treatment of Stanford B aortic dissection(TBAD)with insufficient anchorage zone.Methods:Clinical data of 25 TBAD patients (proximal healthy landing zone ≤15 mm) treated with Castor branched stent-graft at Weifang People's Hospital from Apr 2019 to Sep 2021 were analyzed retrospectively.The stent model was selected according to preoperative CTA examination and intraoperative angiography,the operation result and follow up data were reviewed.Results:The operation success rate was 100%,the mean operative time was (137.8±35.8)min, and the mean blood loss was (52.8±24.5)ml. There were 2 cases of internal leakage (IA) and it was disappeared after balloon dilation, Branched stent stenosis occurred in 2 cases and relieved by balloon dilatation. The mean follow-up time was 14.6 months, and the patency rate of branch stent was 100% during the follow-up period. The true lumen diameter of thoracic aorta was significantly expanded and the false lumen diameter was significantly reduced 3 months after surgery compared with that before surgery ( P<0.05). Conclusion:Castor stenting in the treatment of TBAD with insufficient proximal anchoring area is simple and feasible, with satisfactory short term clinical effect.

A retrospective clinical study of patients with pregnancy-associated breast cancer among multiple centers in China (CSBrS-008) / 中华医学杂志(英文版)

BACKGROUND@#Pregnancy-associated breast cancer (PABC) is a special type of breast cancer that occurs during pregnancy and within 1 year after childbirth. With the rapid social development and the adjustment of reproductive policies in China, the average age of females at first childbirth is increasing, which is expected to lead to an increase in the incidence of PABC. This study aimed to accumulate clinical experience and to investigate and summarize the prevalence, diagnosis, and treatment of PABC based on large multicenter samples in China.@*METHODS@#According to the Chinese Society of Breast Surgery, a total of 164 patients with PABC in 27 hospitals from January 2016 to December 2018 were identified. The pregnancy status, clinicopathological features, comprehensive treatment methods, and outcomes were retrospectively analyzed. Survival curves were plotted using the Kaplan-Meier method.@*RESULTS@#A total of 164 patients of PABC accounted for 0.30% of the total number of cases in the same period; of which, 83 patients were diagnosed during pregnancy and 81 patients during lactation. The median age of PABC was 33 years (24-47 years). Stage I patients accounted for 9.1% (15/164), stage II 54.9% (90/164), stage III 24.4% (40/164), and stage IV 2.4% (4/164). About 9.1% (15/164) of patients were luminal A. Luminal B patients accounted the most (43.3% [71/164]). About 15.2% (25/164) of patients were human epidermal growth factor receptor 2 (Her-2) overexpression and 18.9% (31/164) of patients were triple-negative breast cancer. For pregnancy breast cancer, 36.1% (30/83) of patients received direct surgery and 20.5% (17/83) received chemotherapy during pregnancy. About 31.3% (26/83) chose abortion or induction of labor. The median follow-up time was 36 months (3-59 months); 11.0% (18/164) patients had local recurrence or distant metastasis and 3.0% (5/164) died.@*CONCLUSIONS@#It is safe and feasible to standardize surgery and chemotherapy for PABC.

Gene Nelin induced phenotypic transition of human vascular smooth muscle cells in vitro mediated by RhoA and SRF / 中华普通外科杂志

Objective To explore the mechanism of gene Nelin on the differentiation of vascular smooth muscle cells(VSMC).Methods Human VSMCs were stably infected with over-express lentiviral vector [Nelin-VSMC] and interference lentiviral vector [LV-Nelin-SiRNA-VSMC] by Western blotting and RT-PCR.The effect of Nelin expression on phenotypic transition of VSMCs was observed and the mechanism involved was explored.Results The Nelin-VSMC cells take on the contractile phenotype of long slender cells possessing hill-valley characteristics.Overexpression of Nelin can enhance SMoα-actin expression with the increase of total RhoA and nuclear serum response factor(SRF) expression.Treated with a selective Rho kinase inhibitor Y-27632,the expression of SMα-actin and nuclear SRF protein induced by Nelin was effectively reduced.Meanwhile,the opposite results were observed in the Nelin-depression VSMC.Conclusions Nelin can enhance the expression of SMα-actin and carry a pivotal role in the process of VSMCs differentiation and phenotype modulation by activating Rho and SRF.

Correlation between atrial tissue aldosterone level and atrial extracellular matrix remodelling in patients with atrial fibrillation / 第二军医大学学报

Objective: To investigate the correlation between atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation and to evaluate the effects of aldosterone on the progress of atrial structural remodeling. Methods: Twenty-five patients with rheumatic heart valve disease (12 with sinus rhythm, 13 with chronic atrial fibrillation for ≥6 months) were included in the present study. The right and left atrial lateral wall tissue samples (12 right and 7 left atrial samples in patients with sinus rhythm; 13 right and 8 left atrial samples in patients with atrial fibrillation) were obtained during mitral/aortic valve replacement operation. Radioimmunoassay was used to determine aldosterone level in local atria. Type I or III collagen volume fraction (CVF-I or CVF-III) and total collagen volume fraction (CVF) were analyzed by immunohistochemistry and VG staining, respectively. Results: The left atrial diameters increased markedly in the atrial fibrillation group as compared to those in the sinus rhythm group (P<0.01). Aldosterone level, CVF-I, CVF-I/CVF-III ratio, and total CVF in atrial fibrillation group were also increased significantly than those of sinus rhythm group (P<0.01), whereas CVF-III remained compatible in the 2 groups. Aldosterone level, CVF-I, CVF-I/CVF-III ratio, and total CVF were similar between the left atria and right atria in both groups. It was found that CVF-I was positively correlated with the left atrial dimension (r=0.856, P<0.001), CVF was positively correlated with left atrial dimension(r=0.845, P<0.01), and CVF-I/ CVF-III ratio was positively correlated with atrial fibrillation duration (r=0.766, P<0.01). Aldosterone level in local atria was also positively correlated with left atrial dimension (r=0.814, P < 0.001) and CVF (r = 0.885, P < 0.001). Conclusion: Local atria aldosterone level may promote the process of atrial structural remodeling in patients with atrial fibrillation and may also participate in the development and persistence of atrial fibrillation.

Atrial 11beta-hydroxysteroid dehydrogenase type 2 expression in rheumatic heart disease patients with or without atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the mRNA and protein expressions of 11beta-Hydroxysteroid dehydrogenase type 2 (11betaHSD2) in patients with atrial fibrillation.</p><p><b>METHODS</b>Right and left atrial lateral wall tissue samples were obtained during mitral/aortic valve replacement operation from 25 patients with rheumatic heart valve disease (12 in sinus rhythm and 13 in chronic atrial fibrillation). Realtime quantitative PCR and Western blot were used to determine the mRNA and protein expressions of 11betaHSD2 in atria specimens. The distribution of 11betaHSD2 in human atrial tissue was analyzed by specific immunohistochemical staining. Echocardiography examination was performed before operation.</p><p><b>RESULTS</b>The left atrial diameters were significantly higher in the atrial fibrillation group as compared to sinus rhythm group (P < 0.01). Similarly, mRNA expression of 11betaHSD2 (0.86 +/- 0.14 vs 0.33 +/- 0.12 in right atria, 0.95 +/- 0.15 vs 0.37 +/- 0.10 in left atria, all P < 0.01) and protein expression of 11betaHSD2 (1.18 +/- 0.64 vs 0.71 +/- 0.21 in right atria, P < 0.01; and 1.36 +/- 0.58 vs 0.85 +/- 0.15 in left atria, P < 0.05) were also significantly upregulated in atrial fibrillation groups than those in sinus rhythm groups. The mRNA and protein expressions of 11betaHSD2 were similar between left atria and right atria both in fibrillation and sinus groups (all P > 0.05). The special immunohistochemical staining demonstrated that 11betaHSD2 was abundant in the human atrial myocardium and located mainly in the cytoplasm.</p><p><b>CONCLUSION</b>These findings suggested that upregulated 11betaHSD2 might be associated to the development and persistence of atrial fibrillation.</p>

Study on expression of mineralocorticoid receptor in human atria during atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the mRNA and protein expression of mineralocorticoid receptor (MR) in patients with atrial fibrillation.</p><p><b>METHODS</b>Twenty-five patients with rheumatic heart valve disease, 12 in sinus rhythm and 13 in chronic atrial fibrillation (>or= 6 months), underwent transthoracic echocardiography and right and left atrial lateral wall tissue samples were obtained from these patients during mitral/aortic valve replacement operation. Realtime quantitative PCR and Western blot were used to determine the mRNA and protein expression of MR in atria specimens. The distribution of MR in human atria was analyzed by specific immunohistochemical staining.</p><p><b>RESULTS</b>The left atrial diameters increased markedly in atrial fibrillation group compared with that in sinus rhythm group (P<0.01). And the results showed that the level of mRNA and protein of MR were increased significantly in atrial fibrillation group compared with those in sinus rhythm group (P<0.01 or 0.05), whereas the expression of mRNA and protein of MR were found to be no difference between left atria and right atria both in fibrillation and sinus groups (all P>0.05). The special immunohistochemical staining demonstrated that MR was abundant in the human atrial myocardium and MRs were located mainly in the cytoplasm of atrial cells, which were more evident in atrial fibrillation group than those in sinus rhythm group.</p><p><b>CONCLUSION</b>These findings suggested that MRs were upregulated in atrial fibrillation and aldosterone antagonists may be effective in treating atrial fibrillation.</p>

Ablation of the orifices of the pulmonary veins under direct vision by using the transballoon ultrasound ablation catheter for permanent atrial fibrillation with rheumatic valve disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effect and possibility of surgical ablation of the pulmonary vein orifices under direct vision with transballoon ultrasound ablation catheter for patients with permanent atrial fibrillation and rheumatic valve disease.</p><p><b>METHODS</b>21 consecutive patients with rheumatic valve disease and permanent atrial fibrillation undergoing mitral valve replacement surgery were enrolled for this study from December 2002 to September 2003. All the cases were divided into 2 groups by whether or not receiving an additive pulmonary vein ablation procedure. The test group [6 male, 5 female, aged (51.55 +/- 7.83) years, atrial fibrillation duration (5.50 +/- 5.40) years, left atrial diameter (7.27 +/- 1.39) cm, LVEF (53.95 +/- 4.54)% and NYHA class II - IV] undertook a surgical isolation of the pulmonary vein orifices by using a transballoon ultrasound ablation catheter addition to routine mitral valve replacement. The control group [3 male, 7 female, aged (53.30 +/- 7.86) years, atrial fibrillation duration (4.50 +/- 3.47) years, left atrial diameter (6.74 +/- 0.62) cm, LVEF (56.91 +/- 3.78)% and NYHA class II - IV] received the valve replacement surgery alone.</p><p><b>RESULTS</b>There were not any complications in both groups. With an electrical cardioversion 3 months after the surgery, 73% patients in the ultrasound ablation group were free from AF over 1 year while only 10% patients in control group (P=0.003). During an average follow-up duration of (45.92 +/- 4.61) months, 63.6% were in sinus rhythm in ultrasound ablation group while none in the control group. Left atrial volume decreased significantly at 1 year after surgery compared to that at 3 months after surgery in the test group [(97.83 +/- 32.39) cm(3) vs. (150.78 +/- 52.32) cm(3), P<0.05], and the end systolic diameter (LAESD) and end diastolic diameter (LAEDD) also decreased [(4.12 +/- 0.39) cm vs. (5.09 +/- 0.98) cm, P<0.05, respectively], while there were no apparently changes in the control group.</p><p><b>CONCLUSIONS</b>Ablation of the orifices of the pulmonary veins under direct vision with transballoon ultrasound ablation catheter during mitral valve surgery seems effective to maintain sinus rhythm after electrical cardioversion and could be performed safely. The function of left atrial and cardiac output improved during long term follow-up of 46 months.</p>